A chronic skin condition called dermatitis herpetiformis (DH) normally affects people in the second or fourth decade of life but can also occur at any age and life period. Intense and itchy sensations is the most common symptom that is felt during the condition. The physical manifestations of DH are characterized by the development of intensely itchy hives and the formation of blister-like patches all over the skin, these manifestations of the condition are normally located on the areas of the body like the elbows and the knees and in places like the buttocks; these sites are not the exclusive sites of occurrence and the blisters may form in other areas of the body as well. The intense and itchy sensation often comes accompanied by a burning or stinging sensation in the affected area of the body. Hypersensitivity or an allergic reaction to a substance called gluten present in different food groups like wheat and other grains is the main cause of DH, thus the condition is mainly an allergic reaction to the protein gluten found in carbohydrate rich foods. Celiac disease-a related condition caused by a reaction to gluten is also usually seen in people affected with DH, celiac disease is characterized by abnormalities present in the intestinal lining, it is also known as gluten-sensitive enteropathy or celiac sprue; this related condition is also considered very serious and debilitating to the individual. Gastrointestinal symptoms are however absent in DH affected individuals unlike people afflicted with celiac disease. The treatment of the condition can be carried out in most affected individuals by the by the observance of a strict regimen of prolonged gluten-free diet (GFD), such a diet will remove symptoms of DH and other intestinal abnormalities over time, the need for medication is also removed in most people. The complete elimination of all symptoms may however take up to 8 to 12 months of dietary restriction on average to achieve substantial results. DH afflicted patient have also been observed to show an increased incidence of lymphoma, which is a cancer of the lymph tissues and the lymphatic system in general, different kinds of autoimmune and connective tissue disorders are also known to occur in such individuals. The risk of eventually developing lymphoma along with the DH may be eliminated by following a strict diet of GFD lasting at least five years according to the result of a preliminary study conducted on a group of patients afflicted by the condition. A GFD or the consumption of medication does not necessarily bring relief from DH in all individuals known to suffer from the condition. The presence of sensitivity to other kinds of dietary proteins is also indicated by certain preliminary studies carried out on groups of patients. It is therefore important to check for the presence of other forms of food sensitivities in individuals afflicted with DH and some practitioners do recommend undertaking a restrictive diet or taking an allergy test for known irritations. Some preliminary studies conducted on other groups of patients with DH also suggest the elimination of symptoms in all affected individuals through the use of a milk-free diet. However, some caution is advised as the consumption of milk based foods apparently intensified the symptoms associated with DH in certain patients afflicted with the condition in spite of the fact that these patients consumed a diet free of gluten. But in all patients examined, combining a gluten and milk free diet brought significant improvements in all cases.
Some of the other physical symptoms that can afflict all patients with DH include the recurring difficulty in absorbing different kinds of nutrients especially certain class of substances, these physical symptoms often resemble the types of conditions that are often associated with low stomach acid-defined as hypochlorhydria and those that occur because of an inflammation in the lining of the stomach-in conditions like atrophic gastritis. These conditions can be aggravated internally because of the mild malabsorption leading to other conditions like anemia and can turn into major nutritional deficiencies, where minerals like iron and zinc, the folic acid, the vitamin B12, are all depleted within the body. The loss of bone density and mass is the most serious effect of severe malabsorption of essential minerals into the body. While proper medical research has not been conducted, it is widely held that there may be many additional and subtle deficiencies of the vitamins and minerals. Laboratory studies to check the nutritional level of individuals suffering from DH are for these very reasons suggested as a first step by some doctors; these test help out in diagnosis and in the eventual treatment methodology to be used. Supplements of betaine HCL which is a good source of hydrochloric acid is therefore almost always recommended by such doctors, these can be taken along with supplements of combination multivitamin-mineral tablets supplements-these supplements will help correct the low levels of stomach acid in the affected individuals. One preliminary study reports that the use of para-aminobenzoic acid (PABA) in high dosages of about 9-24 grams daily in patients can apparently lead to a reduction or the complete elimination of skin lesions that often appear as physical symptoms during the occurrence of DH in individuals. Patients with DH can remain free of symptoms for up to 30 months at a stretch if these supplements are administered continuously and on a regular basis. However, these supplementations must occur under medical supervision as some of these supplements especially large amounts of PABA have potential and suspected side effects. Patients afflicted with DH have also been reported to develop a deficiency in the selenium-containing antioxidant enzyme called glutathione peroxidase. While this deficiency was corrected and removed during preliminary and double-blind trials on groups of patients who were administered 10 IU of vitamin E along with 200 mcg of selenium every day for a total trial period of 6 to 8 weeks; the other symptoms did not show improvement in the double blind trial. Apparently some people afflicted by DH may also respond better to the use of a combination of the antibiotic substances, tetracycline, and nicotinamide-which is a form of the vitamin B3, where and if such patients do not tolerate dapsone during drug therapy. A physician must be present if this route of treatment is being opted during the treatment of the patient afflicted with the condition.